Fertility After 35: Cutting Through the Junk Science

A pregnancy test which shows a "positive" result i.e. the woman is pregnan
(Nabokov/Wikipedia Commons)

There are more than 7 billion people on planet Earth, according to the U.S. Census Bureau. Fertility in the human species is not the number one planetary concern it would seem. This fact, however, is of little solace to women around the world trying to decide when to have children. Such questions range from culture to culture and place to place, are subject to the speculative theories of folk medicine, myths handed down from generation to generation, and simple junk science.

According to the Centers for Disease Control and Prevention, a woman’s chances of having a baby "decrease rapidly every year after the age of 30." Dr. Anne Steiner, associate professor at the University of North Carolina School of Medicine, says that's an exaggeration, and that while fertility does decline with age, most women who want to conceive in their 30s will be able to.

Steiner says that as we improve our ability to gather and interpret the data on age and fertility, we're getting more reliable information on when it actually drops off. According to her data, there isn't a major decline in fertility until age 40.

Erin White-Ulvi is a new mom who says that her doctor advised her to start thinking about having children when she was 29-years-old, warning that her fertility would soon be declining.

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Comments [7]

Cindy Lucus
from NJ

As a former infertility patient myself I feel the information presented here is misleading. Being fertile is something that many women don't fully understand is a temporary state of being. Even if they operate from that premise if they walk around believing that most women are fertile through the age of 40 and even beyond-if they miscalculate that or happen to be one of the millions that this is NOT true for there is no going back but for egg donation or adoption. Fertility is something women and men need to be thinking about in their their life plan. That is really the "take away" message here. Most successful people have some kind of a forward-thinking plan for their lives-where do they want to be in their careers in 5 years, do they want to own a home in their lifetime. Planning a family should be no different but many don't plan their lives this way. For example, a woman who is 30 and knows her desired amount of children is 3 is more likely to reach that goal if she doesn't wait until 35 or 37 to have her first child. She is just thrusting herself into the all to real possibility that having those 3 kids becomes statistically less likely the longer she waits. Also 40% of infertility is male-factor. People don't generally assess their future spouses fertility when they get married but what if his fertility is not optimal. Much in life is about knowledge and informed consent. No one wants to get presented with the information after it's too late to do anything about. Give people the real knowledge that 1 in 8 people in the U.S. with face some form of infertility and let them make their informed choices from there.

As a fertility specialist, I see the consequences of delayed childbearing every day and have many patients that regret waiting to conceive. The problem is that we are individuals and these statements seem to say everyone is ok until age 40, when in fact this is very far from the truth. The American Society for Reproductive Medicine (ASRM, asrm.org) recommends that a woman be evaluated for possible fertility issues after only 6 months of unprotected intercourse once you are 35 or more, precisely because there is a documented decline in ovarian reserve starting around age 27. We know that of the approximately 6 million people having trouble conceiving that only about 50% seek medical care despite the fact that fertility treatments in 2013 are mostly successful. The issue is that not enough people talk with their doctors or ask for a check up. I do not think people should worry or panic but using this information as false reassurance and an excuse not to see the doctor would be a real disservice. If you are trying to conceive, talk with your doctor about whether or not you have risk factors for infertility or pregnancy complications. Some people need to be evaluated now, some people can be reassured, but this story seems to imply that no one needs to worry until they are 40 - this is an overly simplistic view of a complex issue.

So glad this is finally being addressed! In the days before reliable contraception many of our grandmothers and great-grandmothers had children well into their forties, whether they wanted to or not. Those who did not were not victims of declining fertility but simply firm about keeping their husbands out of their beds. My gyn told me that many of the "oops" pregnancies she sees are women in their late 30s and early 40s who bought into the myth that older women can't get pregnant. This myth is just another way of trying to control women by making them panic over having other priorities in their lives than motherhood (and to make money for the fertility industry, so that every 35-year old will run to IVF if it takes them more than six months to conceive) and I'm glad it's finally being dispelled by science.

Decline in fertility is a blessing for many women. It means the threat of a compulsory pregnancy, the possibility of abortion, and the inconvenience and physical disruption of contraception are all a past memory. And, for women who are not fortunate to live in a developed country, decline in fertility also means a major threat to mortality and morbidity diminishes. The WHO says 800 women die from preventable causes related to pregnancy and childbirth every day.

So while women in the U.S. and elsewhere are clamoring for pregnancy in an overstretched world, it would be reckless to intimate that pregnancy is morally neutral or even good. Any story covering fertility has an obligation to laud- if not promote- the ethical option of chosen or unchosen infertility.

Stories that play into the pro-natalist narrative not only make social acceptance of infertile and childfree lives more difficult, it also advocates an unsustainable agenda.

It is irresponsible to promote fertility in any way shape or form when there are 7 billion plus people, many orphans that need adopting and a burgeoning ecological crisis that is largely due to the lifestyle of developed world citizens that is perpetuated through procreation. Case in point, each child born in a developed country ultimately adds about 9,441 metric tons of CO2 to the carbon legacy of a parent - about 5.7 times a person's lifetime emissions [P.A. Murtaugh, M.G. Schlax / Global Environmental Change 19 (2009) 14–20]. Instead of congratulating women for conceiving and giving birth, instead we must attend to the ethical issues surrounding procreation.

I think this is somewhat irresponsible. As a 37 year old woman who has been battling infertility since 35, I have been trying to get my friends to wake up and see that they need to start trying to get pregnant earlier. At 32 for example, I thought I would have no problem until age 40.

But the fact of the matter is, a lot of women who have never been pregnant before and never tried to get pregnant may have underlying issues that they will not discover until it's too late. I have severely diminished ovarian reserve. I have poor quality eggs. And now I only have one ovary to boot. If I had started checking up on my fertility numbers at 33, for example, I would have a much better shot at becoming a mother.

On the contrary to your story, I find most women in their 30s have thought they have until 40, "no problem". In fact, they need to start assessing their fertility before 35, so that they have time to plan and take action.

Furthermore, when you look at IVF success rates, it is at age 38 that there tends to be a large decline in success, which is why that age range is broken down in the data. CDC keeps track of < 30, 30-35, 35-37, 38-40, and 40+, I believe. The ability to get the ovaries to respond and the quality of the eggs is different at 38 than 33, and very different at 42.

So please, do not do us women who are trying to have it all any more disservice by perpetuating the belief that our fertility is as persistent as our will, ambition, and work ethic. Because fertility is something that largely cannot be controlled or willed away. We need to assess it and address it early and come up with an action plan. That needs to be the message women need to hear.